Effect of Comprehensive Breast Care on Breast Cancer Outcomes: A Community Hospital Based Study from Mumbai, India

Breast cancer is the second most common cancer in women in India and the disease burden is increasingannually. The lack of awareness initiatives, structured screening, and affordable treatment facilities continueto result in poor survival. We present a breast cancer survival scenario, in urban population in India, wherestandardised care is distributed equitably and free of charge through an employees’ healthcare scheme. Westudied 99 patients who were treated at our hospital during the period 2005 to 2010 and our follow-up rates were95.95%. Patients received evidence-based standardised care in line with the tertiary cancer centre in Mumbai.One-, three- and five-year survival rates were calculated using Kaplan-Meier method. Socio-demographic,reproductive and tumor factors, relevant to survival, were analysed. Mortality hazard ratios (HR) were calculatedusing Cox proportional hazard method. Survival in this series was compared to that in registries across India anddiscrepancies were discussed. Patients mean age was 56 years, mean tumor size was 3.2 cms, 85% of the tumorsbelonged to T1 and T2 stages, and 45% of the patients belonged to the composite stages I and IIA. Overall 5-yearsurvival was 74.9%. Patients who presented with large-sized tumors (HR 3.06; 95% CI 0.4-9.0), higher compositestage (HR 1.91; 0.55-6.58) and undergone mastectomy (HR 2.94; 0.63- 13.62) had a higher risk of mortalitythan women who had higher levels of education (HR 0.25; 0.05-1.16), although none of these results reached thesignificant statistical level. We observed 25% better survival compared to other Indian populations. Our resultsare comparable to those from the European Union and North America, owing to early presentation, equitableaccess to standardised free healthcare and complete follow-up ensured under the scheme. This emphasises thatequitable and affordable delivery of standardised healthcare can translate into early presentation and bettersurvival in India.